Can Jakafi (ruxolitinib) and thyroid medication, such as levothyroxine, be taken together?

Jakafi (Ruxolitinib) and Thyroid Medication Can Be Taken Together with Monitoring

Yes, Jakafi (ruxolitinib) and thyroid medication such as levothyroxine can be taken together, but thyroid function should be monitored as there may be interactions requiring dose adjustments of the thyroid medication. 1

Interaction Between Jakafi and Thyroid Medication

Jakafi (ruxolitinib) and levothyroxine can be administered concurrently, but there are important considerations:

• Studies have identified hypothyroidism as a potential effect when tyrosine kinase inhibitors (TKIs) like Jakafi are used with levothyroxine, though the exact mechanism remains unclear 1
• Monitoring of thyroid function is recommended when these medications are used together 1
• Patients may require thyroid dose adjustments to maintain euthyroid status 1

Recommendations for Co-administration

Timing of Administration

• Take levothyroxine in the morning on an empty stomach, at least 30 minutes before Jakafi
• Separate administration times to minimize potential absorption issues

Monitoring Requirements

• Baseline thyroid function tests (TSH, free T4) before starting Jakafi
• Follow-up thyroid function testing 4-6 weeks after initiating Jakafi
• Regular monitoring every 3 months during the first year of co-therapy
• Adjust levothyroxine dose as needed based on test results

Dose Adjustments

• If hypothyroid symptoms develop or TSH levels increase, the levothyroxine dose may need to be increased
• If TSH levels decrease below normal range, consider reducing levothyroxine dose

Special Considerations

Drug Interactions with Other Medications

• Jakafi is metabolized through CYP3A4, so consider potential interactions with other medications 2
• Avoid combining Jakafi with potent immunosuppressive agents such as cyclosporine or tacrolimus 1

Patient Monitoring

• Watch for signs of hypothyroidism (fatigue, cold intolerance, weight gain)
• Monitor for signs of hyperthyroidism (palpitations, heat intolerance, weight loss)
• Be aware that Jakafi may cause dose-related anemia and thrombocytopenia that require regular monitoring 3

Common Pitfalls to Avoid

1. Failure to monitor thyroid function: Regular testing is essential when using these medications together
2. Improper timing of medications: Taking levothyroxine too close to Jakafi may affect absorption
3. Overlooking symptoms of thyroid dysfunction: Changes in energy, weight, or temperature tolerance may indicate need for dose adjustment
4. Not considering other drug interactions: Both medications may interact with other drugs in a patient's regimen

By following these guidelines and maintaining appropriate monitoring, patients can safely take Jakafi and thyroid medication concurrently while minimizing the risk of adverse effects and ensuring optimal therapeutic outcomes.